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HIV-infected patients present with colorectal cancer at a younger age, with more advanced and with more poorly differentiated disease
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The American Journal of Gastroenterology
Volume 101 Page 907 - April 2006
Volume 101 Issue 4
".....In addition to an increase in the incidence of non-AIDS-defining malignancies, these neoplasms tend to develop at an earlier age and are more aggressive in HIV-infected patients as compared to those without HIV (36, 40-43). In a cancer registry study from Bellevue Hospital in New York City, Demopoulos et al. (43) noted that the mean age at the time of diagnosis of CRC was 51.0 yr in HIV-infected patients as compared with 68.6 yr in those without HIV. Interestingly, Yeguez and colleagues (40) found that the median age of HIV-infected patients with adenocarcinoma of the colon was even younger (46 yr), and 4 of the 6 patients were less than 40 yr old. The increasing incidence, younger age of onset, and more aggressive course of CRC in patients with HIV, coupled with our data showing underuse of screening in these individuals, highlights the need to increase patient and provider awareness of CRC screening in this population. In addition, it is important to assess the potential costs and benefits of CRC screening programs in patients with HIV and to determine whether CRC screening should begin before 50 yr of age...."
36. Chiao EY, Krown SE. Update on non-acquired immunodeficiency
syndrome-defining malignancies. Curr Opin Oncol 2003;15: 389-97.
40. Yeguez JF, Martinez SA, Sands DR, et al. Colorectal malignancies in HIV-positive patients. Am Surg 2003;69: 981-7.
41. Cappell MS, Yao F, Cho KC. Colonic adenocarcinoma associated with the acquired immune deficiency syndrome. Cancer 1988;62: 616-19.
42. Klugman AD, Schaffner J. Colon adenocarcinoma in HIV infection: A case report and review. Am J Gastroenterol 1994;89: 254-6.
43. Demopoulos BP, Vamvakas E, Ehrlich JE, et al. Non-acquired immunodeficiency syndrome-defining malignancies in patients infected with human immunodeficiency virus. Arch Pathol Lab Med 2003;127: 589-92.
Response to Dr. Berretta and Dr. Tirelli
Jean-Pierre Reinhold, M.D.
Craig T. Tenner, M.D.
Michael A. Poles, M.D., Ph.D.
andEdmund J. Bini, M.D., M.P.H.
TO THE EDITOR: We thank Dr. Berretta and Dr. Tirelli for their interest in our article (1).
The data that they present from the GICAT experience provides further evidence that HIV-infected patients present with colorectal cancer at a younger age, with more advanced and with more poorly differentiated disease. Based on their data, they advocate initiating colorectal cancer screening in these patients at 45 yr of age.
Other investigators have also found that HIV-infected patients with colorectal cancer present with more advanced disease and at a younger age than individuals without HIV (2, 3). In addition, we found that HIV-infected patients undergoing screening colonoscopy had a significantly higher prevalence of adenomas compared to an age-, gender-, and family history-matched HIV negative control group (4).
Although we strongly advocate colorectal cancer screening in patients with HIV, the optimal age to begin screening and the appropriate frequency of screening are unknown. HIV is now a chronic disease and many patients are living long enough to develop colorectal cancer. Therefore, large, well-designed prospective studies are needed to confirm our findings and the experience of Drs. Berretta and Tirelli before formal colorectal cancer screening recommendations can be made for these individuals.
Jean-Pierre Reinhold, M.D.
Craig T. Tenner, M.D.
Michael A. Poles, M.D., Ph.D.
and Edmund J. Bini, M.D., M.P.H.
REFERENCES
1. Reinhold JP, Moon M, Tenner CT, et al. Colorectal cancer screening in HIV-infected patients 50 years of age and older: Missed opportunities for prevention. Am J Gastroenterol 2005;100: 1805-12.
2. Demopoulos BP, Vamvakas E, Ehrlich JE, et al. Non-acquired immunodeficiency syndrome-defining malignancies in patients infected with human immunodeficiency virus. Arch Pathol Lab Med 2003;127: 589-92.
3. Yeguez JF, Martinez SA, Sands DR, et al. Colorectal malignancies in HIV-positive patients. Am Surg 2003;69: 981-7.
4. Bini EJ, Green B, Poles MA. High prevalence of colorectal adenomas among asymptomatic HIV-infected patients 50 years of age and older: A prospective screening colonoscopy study. Gastrointest Endosc 2005;61: AB247.
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